Provider Demographics
NPI:1770709883
Name:DELAWTER, STEVEN BRETT JR (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BRETT
Last Name:DELAWTER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1025 N BRAND BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2950
Mailing Address - Country:US
Mailing Address - Phone:818-242-1708
Mailing Address - Fax:818-242-0703
Practice Address - Street 1:1025 N BRAND BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3639
Practice Address - Country:US
Practice Address - Phone:818-242-1708
Practice Address - Fax:818-242-0703
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA295791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice